Note to self: Don’t die

[If you’ve sat and talked to me lately you’ll realise that this has been floating round my head for a while. Time to fumble with the words for it.]
I spend a lot of time thinking about medicine. Sometimes I think I’d prefer to spend my time thinking about medicine than practising it.
My thinking about medicine has changed fairly significantly since I started on this 11 years ago.
I entered medical school as a naive enthusiastic teenager doing medicine because I didn’t have any better ideas.
I spent 5 years pissing about, playing footy, music and mario-kart and enjoyed it thoroughly and learnt nothing.
I started work as an only slightly less naive 23 year old and made lots of mistakes and had my eyes opened to the ravages of disease that run rampant through these fragile, scared human beings.
I learnt the techniques and the lingo and threw all that tehnology had to throw at people often because it was easier to do something than stop and talk and think.
And then I moved to NZ and had an ocean of space and time to learn, think and work with some cool people and it started to have a big impact on what I thought about it.
I saw people declared brain dead and their organs removed and lives saved because of it. I watched many people pass from life to death. I had patients I really, really liked die on me just a few months after we’d busted a gut (sometimes literally) to get them better.
I spoke to endless relatives, I perfected my sympathetic active listening. I told lots of people their loved ones were dead.
I came home and dad got sick and I experinced most of the above from a relatives point of view. He always said “why not me?”
Dad died.
I went back to work a slightly different doctor. I wept a lot easier. I got incredibly angry at some of the regular stresses, discomforts and humiliation that we put patients through on a regular basis.
I got good at my job. I’m pehaps not the person to ask but I think I got pretty good at it.
And all through this I thought and read. Vonnegut,  Hauerwas, Marilynne Robinson, Wendell Berry . I listened to lots of podcasts on evidence based medicine and came away thinking that even the “evidence” doesn’t support most of the silly things we do. At least not in a way that the people we do the things to would care about if we told them the truth.
I got married. I quit work and the space between changed me again.
Let me try to summarise where I stand and I’ll see if I can unpack it later over a few posts:
  • In modern (for the sake of this I mean the past 50/60 years, though it is more apparent recently) society we believe in a certain sense of entitlement – an entitlement to our four score years and ten. Pensions, retirement, leisure time have all contributed to it, but I beleive modern medicine is the most powerful driving force behind this idea that all human beings have a right to 80 years of health and die peacefully in their sleep
  • as a result  we are unsure of what to make of it and feel no way of understanding our own deaths or those of others in the context of the narratives we identify with in many other aspects of our lives. To try and simplify – we let medicine tell us who we are, how we should live and how we should die.
  • we attribute to modern medicine power and glory because we believe it deserves it. Doctors are happy to show us how wonderful they are and we are keen to believe their story.
  • those with faith convictions often appear as scared and confused by early death as non-believers. People who believe in the sovereignty and goodness of God often seem to find their hope in medicine than God. Or put it this way – God will do fine if medicine doesn’t work.
  • In allowing modern medicine such significance and power in our lives and society (sometimes with better reasons than others) we do violence to our own and others humanity
  • as cynical and critical as I am of big pharma I also believe that doctors (often the most powerul lobby amongst health professionals) are key to this.
  • having said that I believe that the medical-industrial-complex is only so because we want it that way. We want to believe the narrative we’re being sold.
I’m not about to quit the profession or anything – I love the job, in fact I feel more than ever the weight and importance of the job and our relation to how we define health and health care.
It does affect me personally though. Whether I like it or not, part of my identity is linked to this. This affects who I am.
These are just some things that have been going through my head. If anyone has any thoughts of how I could develop this a bit further – in the context of books or even how I could study this in an academic setting then I’d love to hear from you.

2 Responses to “Note to self: Don’t die”

  1. 1 David Knowles October 28, 2010 at 7:05 pm

    Hey Andy,

    Hope all is well.

    You might find the following resources useful, if you haven’t already come across them:

    Walter Brueggemann talking about ‘scripts’ and ‘counter-scripts’ (by which he essentially means ‘narrative’ as you’re using it here). This can be found here:

    He may have developed these ideas in greater depth elsewhere, as he’s written a ridiculous number of books.

    Also, Ivan Illich’s book ‘Limits to Medicine’. I can’t say I’ve read this book, but I have read some of his other work, all of which has been very good.

    Hope you are well,
    Tell Wylie I said hi!

  1. 1 Learn to live with what you are « Nelly And I Trackback on December 6, 2010 at 2:29 pm

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October 2010

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